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Background: Myeloid sarcoma is an uncommon malignant neoplasm that typically arises at extramedullary sites and is associated with a diagnosis of acute myeloid leukemia. While myeloid sarcoma can involve any organ, central nervous system involvement is rare, particularly in the adult population. Case Description: An 87-year-old female presented with progressive paraparesis of 5 days’ duration. The magnetic resonance imaging (MRI) revealed an epidural tumor from T4 to T7 with cord compression. When she underwent a laminectomy for tumor resection, the pathology revealed a myeloid sarcoma with monocytic differentiation. Although she improved postoperatively, she elected to pursue hospice care and expired 4 months later. Conclusion: Myeloid sarcoma is an uncommon malignant spinal neoplasm rarely seen in adults. For this 87-year-old female, MRI-documented cord compression warranted decompressive surgery. Although this patient did not opt for adjuvant therapy, other patients with such lesions may undergo additional chemotherapy or radiation therapy. Nevertheless, optimal management for such malignant tumor is still undefined.

Flat epithelial atypia (FEA) of the breast have a tendency to calcify and, as such, are becoming increasingly detected by mammography. There is no consensus yet on whether to excise these lesions or not after diagnosis on core needle biopsies (CNB). We reviewed 3,948 cases of breast CNB between June 2004 and June 2009 correlating histomorphologic, radiological, and clinical features. There were 3.7 % (145/3,948) pure FEA and 1.5 % (58/3,948) concomitant FEA and atypical ductal hyperplasia (ADH). In the pure FEA population, 46.2 % (67/145) had microcalcifications on mammography with 65.5 % (95/145) of patients undergoing subsequent excisional biopsies with the following findings: benign 20 % (19/95), ADH 37.9 % (36/95), ductal carcinoma in situ (DCIS) 1.1 % (1/95), and DCIS and invasive ductal carcinoma (IDC) 2.1 % (2/95). In the concomitant FEA and ADH group, 86.2 % (50/58) patients had microcalcifications on radiograph with 74.1 % (43/58) of patients undergoing subsequent excisions with: benign 23.3 % (10/43), DCIS 9.3 % (4/43), DCIS and IDC 4.7 % (2/43), DCIS + lobular carcinoma in situ + invasive lobular carcinoma 2.3 % (1/43), and tubular carcinoma 2.3 % (1/43). The incidence of carcinoma in the FEA + ADH group is 18.6 % (8/43) and 3.2 % (3/95) for the pure FEA group. This difference is statistically significant (p = 0.0016). The relative risk of carcinoma in the ADH + FEA group versus the pure FEA group is 6.4773, with 95 % CI of 1.8432 and 22.76 24. Five-year mean follow-up in the unexcised pure FEA did not show any malignancies. These findings suggest that pure FEA has a very low association with carcinoma, and these patients may benefit from close clinical and mammographic follow-up while the combined pure FEA and ADH cases may be re-excised.

For the current review a literature search was carried out using Pubmed, EmBase, and Cochrane databases. All cases of prostate angioscaroma reported to date and observational studies evaluating the radiation associated cancer occurrence were reviewed. Despite the rarity, prostate angiosarcomas display remarkable clinical and pathological heterogeneity, and a treatment challenge. We found the association of prostate angiosarcoma with radiation therapy to be weak based upon the results from observational studies and case reports. Although radiation exposure has been suggested etiology of prostate angiosarcomas, assumption of such association is not supported by the current literature.

Angiosarcomas are a relatively rare histological subtype of sarcomas and represent

To evaluate the role of lithocholic acid (LCA) in the etiology of parenteral nutrition-associated cholestasis (PN-AC), we studied (i) the changes in the percentage of biliary LCA and (ii) the emergence and resolution of cholestatic changes in the liver after total parenteral nutrition (TPN) and after 6 weeks of oral feeding following the TPN. We compared these changes in rabbits on TPN support (via a central vein) for 14 days (TPN, n = 8) with those after 6 weeks of refeeding (Post-TPN, n = 8). Age-matched rabbits on lab chow served as controls (CHOW, n = 8). At the end of the diet regimens, the common bile duct was cannulated under anesthesia, and hepatic bile collected for measurements of bile flow and bile acid (BA) secretion rates, and BA profiles. The 60-min biliary excretion of sulfobromophthalein (BSP) after an intravenous bolus (5 mg/kg) was determined. A liver biopsy was taken for light microscopy. After 14 days of TPN, bile flow was reduced by 60%, bile acid secretion by 52%, and BSP excretion by 38%. On refeeding, only the BSP excretory rate recovered fully. In the TPN group, histology of the liver showed hepatocellular degeneration and portal tract inflammation; these resolved after refeeding leaving a mild portal fibrosis in 4/8 rabbits. Total colonic stasis occurred during TPN. With TPN, a decrease in the percentage of biliary glycochenodeoxycholate and an increase in LCA% were seen, whereas after refeeding the increase was in the percentage of glycoursodeoxycholate. An LCA% > or = 6 was associated with liver cell damage. After 6 weeks of refeeding, the structural cholestasis disappeared, but the decreases in basal bile flow and bile acid secretion (functional cholestasis) persisted. These data associate an increase in biliary LCA with the emergence of cholestasis during TPN in rabbits.

Perinatal infarction of the spinal cord is described in two premature babies who survived for several months. In both cases, there was bilateral, multisegmental infarction at the lower cervicothoracic arterial zone (inferior cervical sector), predominantly within the territory of the anterior spinal artery. Clinically, both infants had acute respiratory failure, diaphragmatic respiration, intercostal paralysis, bell-shaped deformity of the thorax, and bilateral arm paresis. Intubation and ventilator support were required for weeks. Eventual extubation was followed by recurrent respiratory failure, atelectasis, and pneumonia. At the level of the infarction, multiple, scattered scars were found in central, perimedullary, and intramedullary arteries, but not in their parent vessels. The etiology of the angiopathy was not determined. These cases demonstrate that discrete arterial infarction of the cord can occur in premature babies, and that such a lesion should be considered in the differential diagnosis of neonatal respiratory failure. (J Child Neurol 1995;10:200-204).

We describe a case of malignant solitary fibrous tumor of the pleura in a 15-year-old female who presented clinically with back pain. Grossly, the tumor had a pedicle attached to the pleura and histologically showed proliferating spindle-shaped cells with a high mitotic index. Immunohistochemical and ultrastructural features were consistent with a tumor of fibroblastic origin. Flow cytometric DNA analysis revealed an aneuploid population among the tumor cells.

Plasmacytoma is a rare B-lymphocyte neoplastic disorder that usually presents as the generalized disease multiple myeloma. Less than 5% of the cases present as a solitary mass of monoclonal plasma cells in the bone or soft tissue. Although solitary extramedullary plasmacytoma (SEP) may arise in any organ, it rarely involves the urinary bladder. A 67-year-old male without a history of multiple myeloma presented with urinary frequency and nocturia; he was later diagnosed with SEP of the bladder. The patient was initially treated with a course of radiation therapy without symptomatic improvement; therefore a chemotherapy regimen consisting of lenalidomide and dexamethasone was subsequently given for six cycles. SEP usually carries a better prognosis and higher cure rate than solitary plasmacytoma of bone, as SEP is radiation sensitive. The role of adjuvant chemotherapy in the treatment of SEP that is resistant to radiation therapy is not clear, since most of the recommendations have been derived from the experience of head and neck SEP. The literature also lacks recommendations for choice of a chemotherapy regimen and surveillance of isolated bladder plasmacytoma. Here we present the first case of a radiation-resistant solitary plasmacytoma of the bladder that was successfully treated with lenalidomide and dexamethasone with successful clinical remission.

Intraductal papillary mucinous tumors (IPMT) are known to occur in the pancreas but rarely can occur in the bile ducts. These tumors secrete mucin that may form mucous plugs resulting in biliary stasis, biliary duct obstruction and dilation. We report a case of IPMT of the biliary tract that presented with fatigue and a persistent cholestatic pattern of liver enzyme elevation and required a high index of suspicion to make the final diagnosis. The early recognition and treatment of these tumors is important, as unlike other bile duct tumors, these have a good prognosis.

An atypical variant of Streptococcus pyogenes was isolated from a discharge from a child's ear. Although this variant streptococcus grew aerobically on chocolate agar, the isolate would not grow on blood agar, the medium used to screen for S. pyogenes, unless it was incubated anaerobically or incubated in air with cocarboxylase.

Patients on total parenteral nutrition (TPN) commonly have hepatobiliary dysfunction. Interruption of the enterohepatic circulation (EHC) and gallbladder stasis are part of the pathogenesis. Cholecystokinin-octapeptide (CCK-OP), by emptying the gallbladder, stimulates the EHC. This study was performed to determine whether daily CCK-OP infusions can ameliorate the hepatobiliary dysfunction caused by TPN.Rabbits maintained on a standard TPN for 12 days were divided into two groups. One group (n = 6) received daily intravenous doses of CCK-OP, and the other (n = 13) received TPN only. A lab-chow-fed (LCF) group (n = 8) served as controls. The authors studied bile flow and bile acid secretion rates, sulfobromophthalein (BSP) secretion, gallbladder emptying in response to CCK-OP, and liver histology.The LCF group had a bile flow of 82.3 microL/kg/min; that for the TPN-only group was 45.7 microL/kg/min (P.001). The daily CCK-OP group did not improve more than the TPN-only group, with a bile flow of 45.8 microL/kg/min (P = NS). Bile acid secretion was 0.64 mumol/kg/min for the LCF group, 0.46 for the TPN-only group (P = NS), and 0.46 for the daily CCK-OP group (P = NS). TPN impaired the ability of the gallbladder to empty, and this was restored with daily CCK-OP. In the LCF group, the mean BSP secretion was 81.7% of a 5-mg/kg bolus within 60 minutes, compared with 72.5% in the daily CCK-OP group (P = NS) and 63.5% in the TPN-only group (P.01). Histological examination of the liver showed that daily CCK-OP produced less periportal inflammation and fibrosis, although all TPN groups had hepatocyte damage in the centrilobular area.Stimulation of the EHC with daily CCK-OP infusions during TPN decreased periportal inflammation and fibrosis, maintained gallbladder emptying capacity, and improved organic anion (BSP) secretion, although bile flow and bile acid secretion were not improved, and hepatocyte damage persisted.